In the case of blunt violent impact, there may be no obvious symptoms in less severe cases, and chest pain, palpitations, shortness of breath and angina in more severe cases. If the injury is caused by a sharp or bladed instrument, the less severe cases may show increased venous pressure, jugular venous anger, distant heart sounds, weak heartbeat, narrow pulse pressure, reduced arterial pressure, or in severe cases, haemorrhagic shock or even death.